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SKIN CARE TODAY
2017,Vol 3, No 1
TOP TIPS
i
Most nurses are familiar with the basics of
good wound care. But what about the skin
surrounding the wound? Here,
Skin Care Today
looks at the care of the periwound area, and
its importance in preventing further
wound breakdown.
Periwound skin care
Why is the periwound
skin important?
1
Nurses can often make the mistake
of focusing exclusively on the wound
itself without taking into consideration
the condition of the periwound skin.
Overlooking this vulnerable area around
the wound, however, can result in its
breakdown and extended wound margins.
The integrity of the often fragile periwound
skin is easily breached if wound symptoms
are not managed effectively. For example,
the application of the wrong dressing to a
heavily exuding wound or fragile skin can
result in damage and increased wound
size. This can be avoided through careful
assessment and dressing selection.
Ongoing assessment of the wound and
surrounding skin is a key factor in protecting
the periwound skin and nurses need to
be aware that wound conditions such as
exudate volume can change over time. It is
important to select management options that
provide an optimum environment for wound
healing while protecting the surrounding
skin according to local conditions at the time
of assessment.
Here, we examine the factors that
can affect the periwound skin, as well
as techniques and products that nurses
can employ to minimise damage to this
vulnerable area.
The effects of exudate
2
Normal wound exudate produced during
the inflammatory phase of healing is rich in
enzymes and growth factors required for the
wound-healing process. In acute wounds, as
healing progresses, the amount of exudate
gradually decreases. However, chronic
wounds become stuck in a prolonged
inflammatory stage and the components of
chronic wound fluid become dysfunctional,
resulting in damage to the wound bed and
surrounding skin. If not managed, chronic
wound exudate can leak onto the periwound
skin, where the enzymes contained within
the wound fluid can begin to break down the
vulnerable and delicate skin.
What is maceration?
3
Over-hydration of the epidemis which
leads to softening of the tissues is known
as maceration. It usually develops when
a wound dressing is unable to handle
the volume of exudate, which, as a result,
overflows onto the surrounding skin. It can
be seen as a white ‘soggy’ discolouration
around the wound edge (such as that seen
on the skin after prolonged bathing).
In patients with venous leg ulcers, for
example, who sit with their legs down, the
maceration may be seen at the base of the
wound, where the force of gravity has caused
the wound fluid to pool.
Macerated skin is weaker than normal
skin and vulnerable to trauma and the
corrosive effects of wound exudate. It is
also more vulnerable to bacterial and fungal
infections due to the warm and moist
conditions created by wound dressings.
Extended contact with wound exudate
can also lead to other symptoms such as the
periwound skin becoming red and inflamed;
there may also be burning, stinging pain and
itching around the affected area.
The danger of skin stripping
4
Repeatedly removing and applying adhesive
tapes and dressings will eventually result
in stripping of the stratum corneum, the
outermost layer of the epidermis. This
outermost skin layer is responsible for
the skin’s integrity and barrier function.
Incorrectly removing wound dressings can
also cause skin stripping, i.e. when they are
removed too quickly. Similarly, some dressing
types should be avoided in patients with a
fragile periwound area, due to their effect
on the skin when they are removed. These
include any dressings, films or fixing tapes
that contain an adhesive.
When removing a dressing, nurses should
follow the guidelines of the manufacturer for
removal. Ideally the surrounding skin should
be supported with one hand before gently
lifting the dressing away with the other hand.
Similarly, loosening the edges of the dressing